HTN - General Information

Hypertension

Overview

Hypertension, or increased blood pressure, is one of the leading health problems that the world is facing today. This condition is difficult to cure; so instead, is generally managed through lifestyle changes and pharmacological therapy. Hypertension is characterized by persistently high arterial blood pressure, or having a high force exerted (per unit) on the walls of the arteries. Hypertension is defined as having a systolic blood pressure at or above 140 mmHg, or diastolic blood pressure at or above 90 mmHg.

5 major effects of hypertension- 3D Medical Animation:

http://www.youtube.com/watch?v=lCLHbwBBvFc

HTN Managing - Picture citation

Statistics

According to the American Heart Association:

• About 80 million people in the United States age 20 and older have HTN
• 33% of all U.S. adults have HTN
• Only 82.7% of people with HTN know they have it
  • 76.5% of those were under current treatment
    • 54.1% have it controlled
    • 45.9% do not have it controlled
• 46% of those with HTN are African-American
• From 1999 to 2009 the death rate from HTN increased 17.1%, and the actual number of deaths rose 43.6%.
• HTN will cost the United States $76.6 billion yearly in health care services, medications, and missed days of work.
• High blood pressure was listed on death certificates as the primary cause of death of 61,762 Americans in 2009.
• High blood pressure was listed as a primary or contributing cause of death in about 348,102 of the more than 2.4 million U.S. deaths in 2009.

American Heart Association - About High Blood Pressure
American Heart Association - Statistics At-a-Glance 2015 Update

According to the Centers for Disease Control and Prevention (2009-2010)

• 29.1% of U.S. adults aged 18 & over had HTN
• 82.8% of adults with HTN were aware of their condition
• 75.8% of adults with HTN were taking medication to lower HTN
• 52.3% of adults with HTN had it controlled

According to the Centers for Disease Control and Prevention (2011):

• 1 in 3 adults has high blood pressure
• 1 in 3 adults with high blood pressure doesn't get treatment

• Nearly 68 million people have high blood pressure but about 1 in 2 doesn't have it under control.

High Blood Pressure - By the numbers




CDC Statistics

Goals

Blood pressure treatment goals**

Less than 140/90mm Hg	If healthy adult age 60 and over
Less than 130/80mm Hg	If healthy adult younger than 60
Less than 130/80mm Hg	If person has chronic kidney disease, diabetes, or coronary artery disease (or at high risk for coronary artery disease)

**Even though having blood pressure lower than 120/80 mm Hg is the ideal goal, clinical studies speculate the necessity of getting patients to that pressure, as it has been shown to be a burdensome on patients and not make much of a difference on overall health outcomes.

http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf

Stages

There are different stages of hypertension depending on your blood pressure reading.

Category	Systolic (top number)		Diastolic (bottom number)
Normal	Less than 120	And	Less than 80
Prehypertension	120-139	Or	80-89
High Blood Pressure
Stage 1	140-159	Or	90-99
Stage 2	160 or higher	Or	100 or higher

These ranges apply to adults 18 years and older who do not suffer from any short-term serious illnesses. It is also important to note that both the diastolic and systolic values do not need to be above average to place an individual in the Stage 1 or 2 category. For example, if an individual has a systolic reading of 165 and a diastolic reading of 80, they would be classified as Stage 2 Hypertension.

Additional Information

Risk Factors

Age:

• Risk of high blood pressure increases with age as blood vessels lose flexibility
• Males ages 45 and over
• Women 55 and over

Race:

• Common among African Americans

Family History:

• High blood pressure tends to run in families
• Increased risk if parents or close blood relatives have had high blood pressure

Overweight and Obesity:

• For overweight and obese individuals, tissues need more blood to supply oxygen and nutrients. The volume of blood traveling through blood vessels increases causing an increased pressure.

Gender:

• High risk for men: early middle age
• High risk for women: after menopause

Low Physical Activity:

• Causes higher heart rate, making the heart work harder with each contraction and causing increased force in arteries.

High Sodium Diet:

• Excessive amounts of sodium in the diet can cause your body to retain fluid, increasing blood pressure.

Low Potassium Diet:

• Potassium helps balance the amount of sodium in your cells. Low potassium in the diet can cause excess sodium accumulation in blood.

Excessive Alcohol Intake:

• More than two or three drinks in a sitting can temporarily raise your blood pressure, and may cause the body to release hormones that increase blood flow and heart rate.

Stress:

• High levels of stress can cause temporary and dramatic increases in blood pressure.

Using Tobacco

• Smoking or chewing tobacco immediately raises blood pressure temporarily. Chemicals in tobacco also damage the lining of your artery walls. Arteries can become more narrow, increasing blood pressure.

Certain Chronic Conditions:

• High cholesterol
• Diabetes
• Kidney disease
• Sleep apnea

Pregnancy:

• Pregnancy can also contribute to high blood pressure

Mayo Clinic - Hypertension
Risks of High Blood Pressure
High Sodium in Diet - CDC

Symptoms of Hypertension

Hypertension is known as the "silent killer" because it generally has no symptoms.

A few common symptoms of Hypertension are:

• Dizziness
• Blurred vision
• Headaches
• Irregular heart beat
• Blood in urine
• Pounding in chest, necks, and ears
• Chest pain
• Nausea

Commonly, symptoms of hypertension are attributed to other risk factors and are overlooked.

Chronic hypertension causes serious damage to many organs.

This link has more information about chronic hypertension symptoms:

Potential Risks and Complications of Untreated High Blood Pressure
Symptoms of Hypertension

Lifestyle Modification

Quick tips to reduce your risk of hypertension & its harmful effects:

AHA's The Simple 7
Follow a weight reduction plan through modifications in diet and exercise as prescribed by a health professional.

• AHA's The Simple 7 - Lose Weight

Improve your diet:

• Include fruits, vegetables, whole grains, lean protein (including fish), and unsaturated fats.
• A general overview of diet related to hypertension
• The DASH eating plan is proven to show blood pressure lowering results within 14 days
• DASH Eating Plan - An Overview
• DASH Eating Plan - Detailed Booklet
• Reduce the amount of salt from your diet to 2300mg per day
• Reduce amount of times eating out at restaurants
• Reduce the amount of overall processed convenience food consumed in the diet
• Taste food before salting or choose other flavorings to season the meal
• Remove the salt shaker from the dinner table
• Prepare foods at home using herbs and spices rather than sodium-containing spice blends
• AHA's The Simple 7 - Eat Better

Get active- incorporate physical activity into your daily life

• Take the stairs; during sedentary time, take breaks to move around
• Instead of driving, walk or bike to nearby destinations
• Play with your kids or friends; a game of frisbee is an example of a fun way to be active
• Take part in traditional organized exercise, such as at a gym, or running outside
• Find a workout partner, a running group, or a recreational sports league to join
• The amount of sedentary time is correlated to hypertension prevalence
• AHA's The Simple 7- Get Active

Certain substances can be counterproductive to the efforts of reducing blood pressure

• Limit alcohol to one drink per day for women, two drinks per day for men
• Avoid caffeine - this will increase blood pressure due to its effect as a stimulant
• Stop the use of tobacco products, especially smoking
• AHA's The Simple 7 - Stop Smoking

De-stress - reducing stress helps to normalize blood pressure

• Close your eyes to clear your mind
• Practice deep breathing exercises
• When feeling stressed, pause, close your eyes, and take 3 deep breaths
• Stretch your muscles or take yoga classes

The amount of blood pressure reduction by intervention type:

Modification	Recommendation	Approximate Systolic Blood Pressure Reduction (range)
Weight reduction	Maintain normal body wt (BMI 18.5 to 24.9 kg/m2)	5-20 mmHg/10 kg wt loss
Adopt DASH diet	Consume diet rich in fruits, vegetables, low fat dairy, and with reduced saturated and total fat content	8-14 mmHg
Dietary Sodium reduction	No more than 100 mmol dietary sodium per day (2.4 g or 6 g Sodium Chloride)	2-8 mmHg
Physical activity	Engage in regular physical activity at least 30 min per day, most days of the week	4-9 mmHg
Moderation of alcohol consumption	No more than 2 drinks per day for men, and 1 drink per day for women and lighter weight persons	2-4 mmHg

Medical Treatment

• Thiazide diuretics
  • Anti-hypertension therapy with diuretics is particularly effective when coupled with reduced dietary sodium intake. The efficacy of these drugs is derived from their ability to reduce blood volume, cardiac output, and with long-term therapy, systemic vascular resistance. The vast majority of hypertensive patients are treated with thiazide diuretics.
• Beta blockers
  • Beta-blockers "block" the effects of adrenaline on your body's beta receptors. This slows the nerve impulses that travel through the heart. As a result, your heart rate will slow down. This slowing decreases the heart's need for oxygen and lowers its workload.
• Angiotensin-converting enzyme (ACE) inhibitors
  • ACE inhibitors relax the blood vessels by preventing the formation of angiotensin II in the body, which narrows (Vasoconstricts) the blood vessels therefore causing higher blood pressure.
• Angiotension II receptor blockers
  • This blocks the action of angiotensin II, an enzyme that is responsible for causing the blood vessels to narrow. If the blood vessels are relaxed, your blood pressure is lowered and more oxygen-rich blood can reach your heart.
• Calcium channel blockers
  • Calcium channel blockers slow the rate at which calcium passes into the heart muscle and into the vessel walls. This relaxes the vessels making it easier for blood to flow through the vessels, which lowers blood pressure.
• Renin inhibitors
  • Direct renin inhibitors block the enzyme renin from triggering a process that helps regulate blood pressure. As a result, blood vessels relax and widen, making it easier for blood to flow through the vessels, which lowers blood pressure.

Information about the Medications



Resources-
http://www.medicinenet.com/high_blood_pressure_hypertension/page4.htm#what_are_the_potential_risks_and_complications_of_untreated_high_blood_pressure
http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_462020.pdf
http://www.youtube.com/watch?v=lCLHbwBBvFc
http://www.heart.org/HEARTORG/
http://www.mayoclinic.com/health/high-blood-pressure/DS00100/DSECTION=risk-factors
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/Understand-Your-Risk-for-High-Blood-Pressure_UCM_002052_Article.jsp
http://www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-symptoms-high-blood-pressure
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
http://www.mayoclinic.com/health/high-blood-pressure/DS00100/DSECTION=treatments-and-drugs
http://www.cvpharmacology.com/diuretic/diuretics.htm
http://www.webmd.com/hypertension-high-blood-pressure/direct-renin-inhibitors-for-high-blood-pressure
http://circ.ahajournals.org/content/123/4/e18.full.pdf
http://www.youtube.com/watch?v=pPxnIh_WTb8&feature=related
http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2009/August/Medications-for-treating-hypertension
http://www.mayoclinic.com/health/beta-blockers/HI00059
http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
http://www.cdc.gov/VitalSigns/CardiovascularDisease/index.html
http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/basics/treatment/con-20019580
http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/ace-inhibitors/art-20047480